Dizziness (Dizzy) (cont.)

Benjamin Wedro, MD, FACEP, FAAEM

Dr. Ben Wedro practices emergency medicine at Gundersen Clinic, a regional trauma center in La Crosse, Wisconsin. His background includes undergraduate and medical studies at the University of Alberta, a Family Practice internship at Queen's University in Kingston, Ontario and residency training in Emergency Medicine at the University of Oklahoma Health Sciences Center.

Melissa Conrad Stöppler, MD

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

How is dizziness diagnosed?

The diagnosis of dizziness begins with the health care professional deciding whether the complaint of dizziness refers to lightheadedness or vertigo. Further diagnosis continues once this distinction is made.

The key to the diagnosis of dizziness is a thorough history and physical examination. Often the diagnosis is made by listening to the patient's story. The health care professional may ask about triggers that cause and relieve the symptoms of dizziness.

"Is it related to changing positions quickly?"

"Does it resolve on its own or does the patient have to do something, like lie down to make it better?"

"Does turning the head bring on the symptoms? Do the symptoms resolve when the patient is very still?"

"Is there associated hearing loss or ringing in the ears?"

A review of systems is a series of questions that review the patient's body functions. Questions may be asked about associated symptoms including fever, vomiting, diarrhea, chest pain, shortness of breath, palpitations, or abnormal bleeding.

The past medical history may be reviewed, and this includes reviewing medications the patient is currently taking.

A thorough physical examination will likely be done; this may include:

Vital signs: Taking the patient's blood pressure and pulse rate lying down and standing (called orthostatic or postural vital signs) often will indicate the fluid status of the body. In patients who are dehydrated or bleeding, the blood pressure may fall and pulse rate may rise on changing position. However, patients taking medications like beta blockers will not generate an increased pulse rate.

Tailored physical examination: Often, the physical examination is tailored to the patient based upon the information provided in the patient's medical history. For example, a woman with a heavy menstrual period may need a pelvic examination, or a patient with cough and shortness of breath may need a closer examination of the heart and lungs. A patient thought to have vertigo will have closer focus on the neurologic exam, including the cerebellum, the portion of the brain responsible for balance and coordination.

Imaging studies and blood tests: The need for imaging studies and/or and blood tests will depend on the concerns the health care professional and patient have in regard to the cause of the dizziness. Common tests that may be ordered include: